A comprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary process designed to evaluate the medical, psychosocial, and functional needs of older adults. By systematically gathering information across several key domains, healthcare professionals can develop a more complete and relevant picture of a patient's overall health than a standard medical evaluation alone. This guide breaks down the process of conducting a thorough CGA.
1. The Pre-Assessment and Initial Information Gathering
Before beginning the assessment, it is important to gather preliminary information. Common reasons for initiating a geriatric assessment include a recent fall, cognitive changes, or new difficulty with daily activities. The first steps involve:
- Gathering context: Ask the patient, or their caregiver, about the primary reason for the visit. For patients unable to articulate their concerns, family members can provide crucial context.
- Reviewing symptoms and impact: Conduct an open-ended discussion about any changes in health or daily routines. This helps uncover secondary concerns that might not be immediately obvious.
- Performing a detailed medical and medication review: A comprehensive review should cover all diagnosed chronic illnesses, past hospitalizations, and current medications. For older adults, polypharmacy can increase the risk of falls and cognitive decline, so a careful review is essential. Tools like the Beers criteria can be helpful.
2. Functional Assessment
Functional status refers to a person's ability to perform tasks necessary for living independently. This evaluation is a cornerstone of the CGA. It includes:
- Activities of Daily Living (ADLs): These are basic self-care tasks. Assessment tools like the Katz ADL scale can be used to evaluate a person's ability to perform tasks such as eating, dressing, bathing, and using the toilet.
- Instrumental Activities of Daily Living (IADLs): These are more complex skills needed for independent living. The Lawton IADL scale is a common tool for assessing abilities like managing finances, preparing meals, and shopping.
- Mobility and balance: Observe the patient's gait as they walk. A rapid assessment can include the "Timed Up and Go Test," where the patient is timed as they rise from a chair, walk 10 feet, turn, and sit back down. A time of over 12 seconds may indicate an increased fall risk.
3. Cognitive and Mental Health Assessment
Cognitive and mental health issues are often underdiagnosed in older adults but can significantly impact independence.
- Cognitive screening: Brief tests like the Mini-Cog (three-item recall and a clock-drawing test) or the Montreal Cognitive Assessment (MoCA) can help screen for cognitive impairment. A positive screen warrants a more in-depth evaluation.
- Depression and anxiety screening: Evaluate mood fluctuations and screen for depression using tools like the 15-item Geriatric Depression Scale (GDS). Addressing mental health issues is critical for improving overall well-being.
- Memory assessment: Even basic memory screening can help identify early signs of cognitive decline, as initial signs of dementia can appear years before the actual onset.
4. Psychosocial and Environmental Assessment
This domain assesses the patient's support network and living environment, which are crucial for maintaining independence and quality of life.
- Social network and support: Ask about the patient's living situation, caregiver involvement, and relationships with family and friends. The Lubben Social Network Scale can quantify the extent of a person's social network.
- Financial status: Address any financial concerns that could impact the patient's ability to afford medications, housing, or follow-up care.
- Caregiver burden: For patients with caregivers, it is important to assess the emotional and physical challenges the caregiver may be experiencing. High caregiver stress can compromise the care provided.
- Environmental hazards: Identify potential hazards in the home environment, especially for patients with a history of falls. This can include poor lighting, loose rugs, and lack of grab bars.
5. Nutrition Assessment
Malnutrition is often insidious in older adults and can significantly impact function and health outcomes.
- Screening for malnutrition: The Mini-Nutritional Assessment Short-Form (MNA®-SF) is a quick and effective tool for identifying individuals at risk. It uses questions about food intake, weight loss, and BMI.
- Weight monitoring: Unintentional weight loss of more than 5% in six months is a key indicator that warrants further nutritional investigation.
Comparison of Geriatric Assessment Tools
| Domain | Rapid Screening Tool | Comprehensive Assessment Tool | Key Features |
|---|---|---|---|
| Functional Status (ADLs) | Katz ADL Scale | OARS Multidimensional Functional Assessment Questionnaire | Evaluates self-care tasks; OARS includes non-physical domains |
| Functional Status (IADLs) | Lawton IADL Scale | OARS Multidimensional Functional Assessment Questionnaire | Evaluates complex skills like managing finances and medication |
| Cognitive Screening | Mini-Cog | Montreal Cognitive Assessment (MoCA) | Mini-Cog is faster and combines recall and clock drawing; MoCA is more in-depth |
| Depression Screening | Geriatric Depression Scale (GDS-15) | Beck Depression Inventory | The GDS-15 is a reliable, rapid questionnaire for older adults |
| Malnutrition Screening | MNA® Short-Form (MNA®-SF) | Full Mini-Nutritional Assessment (MNA®) | MNA®-SF is a quick screen; the full version offers a more detailed assessment |
| Fall Risk | Timed Up and Go Test | Tinetti Balance and Gait Evaluation | Timed Up and Go is a simple gait observation; Tinetti is a more comprehensive balance and gait test |
| Social Support | Lubben Social Network Scale-6 (LSNS-6) | ESSI or Norbeck Social Support Questionnaire | LSNS-6 is a quick, six-question screen for network size |
Conclusion
Performing a geriatric assessment is a vital, systematic process that goes beyond a standard physical exam to address the complex, multidimensional needs of older adults. By carefully evaluating functional ability, cognitive and mental health, psychosocial circumstances, and nutrition, healthcare professionals can identify subtle but critical issues that might otherwise be overlooked. The insights gained from a CGA are instrumental in developing a coordinated and effective care plan, ultimately improving the patient's independence, safety, and overall quality of life. This multidisciplinary approach ensures that all facets of an older person's well-being are considered, paving the way for personalized and proactive care.
